Ablative Lasers and Phenol Peels in Retrospect

Author: admin

27Feb

Lasers used in the aesthetic medicine are divided into ablative and non-ablative groups.

Among the ablative lasers are the CO2 and Erbium:YAG (Er:YAG) lasers. The predominant use of both is for static wrinkles, as opposed to dynamic wrinkles—those created by smiling or laughing. They can also treat dyspigmentations on the face, neck and other parts of the body. As a general rule, we do not use a laser to replace a knife to cut into tissues, but as a tool to resurface. Thus, procedures done with either CO2 or Erbium lasers are typically defined as “laser skin resurfacing”. If you smile and you get crow’s feet, this is best treated with botox injections. However, if you are sitting at rest and you have fine static lines under your eyes, this is best treated with one of these two laser groups.

CO2 lasers are largely considered to be the first cosmetic lasers, which are used less and less these days. The most popular laser among plastic surgeons in the U.S. is the Erbium:YAG. It is used most frequently for fine lines under the eyes and around the mouth for the vertical lip lines. Full face resurfacing, both deep tissue resurfacing and gentle laser peels, are also very commonly offered by physicians’ aesthetic practices. These lasers are also used to treat wrinkles in conjunction with facial surgery, such as a facelift or an eyelid surgery (Blepharoplasty), in one sitting. The big criticism with CO2 was that it caused a lot of undesired pigmentation, and some experts say that the CO2 laser is “unforgiving”, especially in the hands of the less experienced. CO2 typically require a much longer healing time (downtime) and more post-operative care.

The Er:YAG laser provides superficial ablation and is generally used for more superficial rejuvenation. Most people now prefer laser procedures that have minimal associated recovery. Erbium is a preferred modality for such procedures as photoaging, acne scars, superficial cutaneous problems, and rhinophyma. Some laser systems provide for thermal-coagulative and ablative properties. These systems are considered as intermediate resurfacing lasers, providing faster healing and results that are typically in between those of the CO2 and standard Er:YAG lasers.

Up until the mid 1990s, phenol peeling (aka chemical peels) was the most popular technique for treating wrinkles and preceded facial resurfacing laser techniques, but this technique also commonly caused hypopigmentation. Even if you did not go too deep, phenol is melanotoxic and would still cause some degree of depigmentation. Besides, the level of control in the application of chemicals is limited to the expertise of the provider.

Phenol is now experiencing a resurgence in popularity, as is the CO2 laser. Cosmetic physicians are getting excellent results with phenol peels and CO2 lasers because the chemistry is now much better understood, which allows them to achieve better results with fewer adverse events. Although ablative resurfacing lasers can achieve excellent results, their major drawback is they do cause significant edema and erythema, which may last for many weeks, and they can cause potential scarring. Therefore, the recovery times are relatively long.

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